Professional Documents
Culture Documents
85760-Điều văn bản-192051-1-10-20231106
85760-Điều văn bản-192051-1-10-20231106
https://doi.org/10.56097/binhduonguniversityjournalofscienceandtechnology.v6i3.173 87
Legislation on insurance contracts - some inadequacies and recommendations for
finalization
legal rights and interests of the parties the contract related to random risks; (ii) The
involved in insurance business activities. performance of the IC is primarily to
2. Overview of Insurance Contracts mitigate and address the consequences of
risks; (iii) When entering into an IC, parties
Insurance is an activity where the insured
cannot foresee the consequences in
commits to compensate the policyholder in
advance; (iv) Determination of the insurer's
the event of a risk within the scope of
responsibility depends on whether
insurance, with the condition that the
insurance events occur or not [2, p. 11].
policyholder must pay a premium. This
Paragraph 1 of Article 15 of LIB 2022 has
means the policyholder transfers the risk to
made adjustments regarding types of ICs
the insurer by paying a premium to create a
compared to LIB 2000 [3], specifically
reserve fund. When the policyholder
including: Life ICs, Health ICs, and Non-
encounters a risk resulting in a loss, the
life ICs (Property ICs, Damage ICs, and
insurer will use the reserve fund to make
Liability ICs).
payments or compensate for damages
within the scope of insurance to the LIB 2022 also introduces a series of
policyholder [1, p.11-12]. This insurance amendments and supplements to meet the
activity has given rise to a legal relationship requirements of consistency and uniformity
between the insurer and the policyholder within the relevant legal system and new
based on the insurance contract (IC) as well requirements arising from practice,
as the provisions of the law. addressing the shortcomings of policy
mechanisms and the market. This ensures a
Inheriting the provisions of LIB 2000,
complete, transparent, equitable system of
Article 4(16) of LIB 2022 defines: "IC is an
insurance business policies, in line with
agreement between the policyholder and the
Vietnam's international commitments and
insurance company, the foreign non-life
following international standards for
insurance branch, microinsurance
insurance management and supervision,
cooperative organization, under which the
suitable for socio-economic development.
policyholder must pay a premium, and the
Some notable new points related to ICs
insurance company, the foreign non-life
include the addition of provisions regarding
insurance branch, microinsurance
the principles of concluding and performing
cooperative organization must compensate,
ICs in Article 16; the supplementation and
pay insurance money according to the
improvement of provisions related to the
agreement in the contract." From this
content and form of ICs in Articles 17 and
definition, it can be seen that the IC is
18 of LIB 2022; clarification of cases for
considered a legal form of the insurance
unilateral termination of IC performance
mechanism, reflecting an agreement to
and legal consequences in Article 26, 17 of
transfer risks between the policyholder and
LIB 2022; supplementation of provisions
the insurer (insurance company, foreign
regarding specific issues of group ICs
non-life insurance branch, microinsurance
(Article 42 of LIB 2022). Despite the initial
cooperative organization). Under this
successes achieved, LIB 2022 still has some
agreement, the policyholder pays a
remaining shortcomings and overlaps,
premium (which can be considered as the
which the author analyzes and comments on
cost of the risk) in exchange for a financial
below.
guarantee with the condition attached to the
occurrence of risks (insurance events) that 3. Current Provisions on Insurance
the policyholder may face [2, p.10]. The IC Contract Exclusion Clauses and
has several fundamental characteristics that Recommendations for Improvement
distinguish it from other types of contracts, 3.1. Provisions on Insurance Contract
including (i) Agreements among parties in Exclusion Clauses
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Tran Linh Huan, Pham Thi Hong Tam
According to LIB 2000 and LIB 2022 LIB 2022). According to the definition of
regulations, exclusion clauses in ICs are exclusion clauses in ICs in Article 19 of LIB
understood as cases in which insurance 2022, cases listed under Article 40 of LIB
companies branches of foreign non-life 2022 are deemed as instances of exclusion
insurance companies are not obligated to of insurance liability. These cases include:
provide compensation or pay insurance a) The insured's suicide within 2 years from
money [4]. In other words, when the insured the date of the first premium payment or the
events are excluded from coverage in the effective date of the IC continuation; b) The
IC, even if such events occur, the insured's death due to the intentional fault
policyholders will not receive insurance of the policyholder or the intentional fault
payouts or compensation. of the beneficiary; c) The insured's
Under the provisions of Article 17 of permanent disability due to the intentional
LIB 2022, the content of ICs is not fault of the insured, the policyholder, or the
mandatory to include exclusion clauses, as beneficiary; d) The insured's death as a
required by LIB 2000. This represents a result of the death penalty. All these cases
progressive development as it removes involve intentional acts or legal violations.
obstacles to designing insurance products Additionally, Article 40 of LIB 2022 allows
without such clauses, safeguarding the parties to the contract to agree on other
autonomy of the insurance parties. cases where the insurer is not obligated to
Furthermore, in cases where exclusion compensate or make payments under the
clauses are included in the IC, the insurer IC.
must clearly and comprehensively explain From the above analysis, it can be
these clauses to the policyholder. The affirmed that the provisions regarding IC
purpose of exclusion clauses in ICs is to exclusion clauses are essential to protect the
limit the insurer's liability in specific insurer and ensure the humanitarian
circumstances, which are as follows: principles of insurance. However, the
First, to ensure that the insurance company current regulations still have certain
does not face the risk of insolvency when obstacles and limitations, as described
significant losses occur, such as those below:
caused by natural disasters or war. One of Firstly, LIB 2022 only defines the IC
the fundamental principles of insurance is exclusion clause and requires insurance
to "spread the risk among many," meaning companies to explain the exclusion clause
that insurance functions properly when the to the policyholders when concluding an IC
number of insured individuals significantly without specifying any limitations,
outweighs those exposed to specific risks in conditions, or principles regarding the
life, for which the insurance company must determination of cases in which insurance
fulfill its insurance obligations. Therefore, companies, branches of foreign non-life
to uphold this principle, excluding the insurance companies, are exempted from
insurer's liability in certain exceptional their insurance liability. This could lead to
cases is necessary. a situation where insurers may abuse this
Second, to protect the insurer from right by introducing numerous unfavorable
events that are not considered risks—cases exclusion provisions to policyholders,
in which the policyholder or the beneficiary thereby serving as a basis for refusing to
intentionally triggers the insured event for fulfill insurance obligations when risks
personal gain. Such intentional acts occur. For example, in Article 4.3.ii.a of the
contradict the principle of fortuitous risk— regulations and terms of the "Peaceful
insurable risks should be unexpected and Longevity" insurance policy (approved by
unforeseeable (Article 16, Paragraph 5 of Official Letter No. 1746/BTC-QLBH on
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Legislation on insurance contracts - some inadequacies and recommendations for
finalization
December 22, 2010, and amended and read and understand every clause in an IC.
supplemented by Official Letter No. ICs are written in specialized terminology
6740/BTC-QLBH on May 24, 2011, of the that may be difficult for ordinary
Ministry of Finance) of AIA Vietnam Life individuals to comprehend. However, the
Insurance Company Limited (AIA): "No law always respects the parties' agreement
insurance benefit shall be payable if: a. The to the contract, provided that the transaction
insured person does not survive for at least aligns with the regional language
thirty (30) days after being diagnosed with understanding, does not contravene legal
a critical illness." In practice, disputes have provisions, and adheres to social and ethical
arisen between AIA and its customers when standards. In this case, it is essential to
the company invoked a similar provision to understand Mrs. T's intent in purchasing
deny insurance payouts. Specifically, just insurance to safeguard against the
five days after being diagnosed with an unfortunate events of death, illness, and
illness, Mrs. T (the insured person) passed disability due to accidents and to receive
away, and the insurance company refused to compensation for financial risks. Therefore,
pay the insurance benefits based on the it should be understood that the terms of the
aforementioned provision in the IC. The IC executed between Mrs. T and AIA must
court of first instance and the appellate be explained in accordance with Article 409
court invalidated the exclusion clause, of the 2005 Civil Code, applying the general
citing the following arguments: spirit of civil law to resolve the matter. The
(i) The Civil Code respects the principle analyses above illustrate that the court of
of freedom of contract and self- first instance compelled AIA to pay Mrs.
determination of the parties to the contract. T's beneficiaries the amount of VND
However, the law also stipulates that civil 120,000,000 based on legal grounds" [5, p.
transactions must be in accordance with 61-62].
local customs, morals, and good traditions, The court's approach is persuasive and
meaning that they must align with reasonable, based on the principles of social
traditional moral and ethical values and ethics and fairness in civil law when there
regional language understanding. In this are no detailed provisions to protect the
specific case, it is necessary to understand legitimate rights of the policyholder
the policyholder's intent as insuring against regarding the exclusion clauses. However,
the risk of death, critical illness, and it can be observed that the court relied
accidents, which should be compensated solely on the most general principles in civil
(except for suicide, execution, murder, or law that were in effect at the time of the trial
death from old age). Deeming that Mrs. T and that LIB 2022 did not provide any
passed away less than 30 days after specific regulations or limitations regarding
diagnosis, as stipulated in Article 5, is the invalidation of unreasonable and unfair
illogical in the context of life and does not exclusion clauses introduced by insurers.
align with the policyholder's intent. It LIB 2022 creates a space for insurance
should be understood that the contract companies to design their insurance
executed between Mrs. T and AIA must be products, including the discretion to
explained in accordance with Article 409 of determine cases of exclusion of insurance
the 2005 Civil Code. Therefore, the general liability. The rules and terms of the mixed
spirit of civil law should be applied to insurance product covering serious
achieve a legal approach closer to justice"; illnesses, paid over three extended periods
(ii) Considering the entire main contract by Manulife Vietnam Limited Liability
terms and supplementary insurance product Company, as approved in Official Letter
clauses provided by AIA. Not everyone can No. 1997/BTC-QLBH dated February 20,
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Tran Linh Huan, Pham Thi Hong Tam
2019, by the Ministry of Finance in Article beneficiaries are not covered for their risks,
19.2 regarding the exclusion of liability for such as death even though they did not
insurance events directly related to the participate in causing riots or violence, or
causes of explosions or radiation from HIV infection and AIDS outside of working
nuclear weapons, chemical, and atomic hours, without any intention.
weapons, and exposure to radioactive Based on the analysis presented above,
contamination from nuclear and atomic the author proposes that LIB 2022 should
installations. The rules and additional include provisions in a generalized manner
insurance terms for global health care regarding limitations, conditions, or
insurance products by Dai-Ichi Life principles for determining cases of
Insurance Company of Vietnam Limited, as exclusion of insurance liability, which
approved in Official Letter No. could be stipulated as follows: "Cases of
11916/BTC-QLBH dated September 30, exclusion of insurance liability may only be
2020, by the Ministry of Finance, in Article agreed upon to ensure the insurer's ability to
3 regulating the exclusion of insurance pay or exclude cases of insurance abuse by
liability, only narrow the scope of insurance the policyholder or the insured." One
by primarily listing specific diseases and mechanism to effectively control the
injuries that are not covered by this product. creation and inclusion of exclusion clauses
The rules and terms of the whole life by insurance companies and foreign non-
insurance product with annual cancer life insurance branches in contracts is
benefit extension by Prudential Vietnam through the registration process of
Assurance Private Limited Liability insurance product models by the Ministry
Company, approved by the Ministry of of Finance, serving as a "filter" to eliminate
Finance in Official Letter No. 8912/BTC- provisions that could infringe upon the
QLBH dated July 4, 2017, in Article 7.1 rights and legitimate interests of the
regarding exclusions in the event of the policyholder in the IC [6]. However, the
insured's death, also list reasons related to effective role of the Ministry of Finance in
war (declared or undeclared), riots, civil this regard has not been fully realized
unrest, or violence. The rules and terms of because, in practice, ICs, despite being
the life insurance product linked to 2018 registered, still contain many provisions
entities, approved by the Ministry of lacking fairness and violating LIB
Finance in Official Letter No. 2536/BTC- regulations.
QLBH dated March 7, 2018, with
Secondly, in addition to the obligation to
amendments and supplements in Official
provide clear and comprehensive
Letter No. 1223/BTC-QLBH dated
explanations of the insurer's exclusion
February 10, 2020, in Article 10.1.1.c
clauses, Article 19.2 of LIB 2022 also sets
include cases of HIV infection, AIDS, and
the requirement that such explanations must
diseases related to AIDS, except for cases
be supported by evidence. Some opinions
of HIV infection while performing duties at
argue that imposing such a requirement
the workplace as a medical or law
creates an invisible hurdle, leading to
enforcement personnel.
inequality among parties and procedural
From the aforementioned real-world inconvenience when entering into contracts
examples, it is evident that there is a variety [7]. Considering the purpose of this
of cases involving the exclusion of provision, which is to protect the
insurance liability. However, there are still policyholder—the weaker party with less
situations where insurance events occur specialized knowledge and less familiarity
randomly, and genuine losses or damages with IC negotiations—supplementing such
exist, but the insured individuals or a requirement is necessary to reduce
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Legislation on insurance contracts - some inadequacies and recommendations for
finalization
disputes, complaints, and litigation related whereby the policyholder can receive cash
to inadequate explanations or lack of surrender value in the following cases:
understanding of crucial content such as (i) When an insurance event occurs, the
exclusion clauses. However, LIB 2022 non-life insurance company or foreign non-
provides no principles or framework for this life insurance branch is not required to pay
confirmation evidence. Therefore, the insurance benefits or compensation.
confirmation evidence could be a separate
(ii) Various unilateral contract
document, the policyholder's signature on
termination scenarios, such as the
the insurance application confirming the
policyholder not paying insurance
explanation of the IC, including exclusion
premiums or not paying the full insurance
clauses, or other evidence to accommodate
premiums, disagreement between the
electronic contract negotiations. Thus, if the
parties regarding changes in the insured risk
IC contains a provision stating that the
level, or the policyholder refusing to
policyholder has explained the exclusion
transfer the policy portfolio.
clause, can that contract be considered
confirmation evidence? In practice, the Due to the savings nature of most life
insurer may provide explanations merely as insurance products, the amount of
a formality, prompting the customer to sign premiums paid at a certain point in time
a confirmation document or verbally exceeds the total natural insurance
providing explanations that may not be premium. Consequently, the contract has a
consistent or contradict the terms of the IC. cash surrender value. Therefore, this
Moreover, LIB 2022 also lacks provisions amount belongs to the policyholder and
regarding the legal consequences of must be returned to them.
violating this duty to explain, leading to The term "account value" is mentioned
inconsistency and confusion in handling in Article 116.3 of LIB 2022 as one of the
such cases in practice. amounts that the insurance company or
Based on the analysis above, the author reinsurance company must pay when
proposes that LIB 2022 should incorporate dividing assets due to bankruptcy. Clearly,
the following provisions: "cash surrender value" is an industry-
specific term in the insurance field.
(i) Confirmation evidence for explaining
However, when reviewing the provisions of
insurance exclusion clauses must be in
LIB 2000 and LIB 2022, even including
written form, audio recordings, video
Civil Code 2015, there needs to be a
recordings, or electronic data as regulated
definition or explanation of this industry-
by electronic transaction laws, and it should
specific term. This lack of definition fails to
encompass the entire content of the insurer's
ensure the transparency of legal regulations,
explanation, including foreign non-life
leading to different interpretations and
insurance branches.
difficulties for policyholders when
(ii) In cases where the IC contains accessing this market [8].
different exclusion clauses compared to the
In practice, insurance companies use
confirmation evidence, those different or
various terms, making it challenging to
omitted clauses should not apply in the
determine which term corresponds to "cash
event of an insurance occurrence.
surrender value" or "account value" as
3.2. Regarding the Terminology of "Cash defined in LIB 2022. Additionally,
Surrender Value" and "Account Value" calculating the actual amount of cash
The term "cash surrender value" is surrender value or account value is
mentioned in Article 37.4, Article 40.3, extremely complex and difficult to
Article 27.3, and Article 27.4 of LIB 2022, understand.
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Tran Linh Huan, Pham Thi Hong Tam
Based on the analyses presented above, both parties are still capable and willing to
to ensure a uniform understanding of cash continue [9]. On the other hand, according
surrender value, the author proposes that to Article 3.2 of the 2015 Civil Code, which
LIB 2022 should include definitions and lays down the fundamental principles of
explanations for "cash surrender value" and civil law, individuals and legal entities can
may explain "cash surrender value" as establish, exercise, and terminate their civil
follows: "Cash surrender value is the rights and obligations based on voluntary
amount owned by the policyholder and and consensual agreements, provided that
returned to the policyholder when the life these agreements do not violate any
IC terminates without an insurance event. prohibitive provisions of the law and are in
The cash surrender value equals the total line with social ethics. Therefore, imposing
premiums paid by the policyholder plus any conditions as described above is
accrued interest (if applicable) minus the unnecessary.
total fees/costs/liabilities owed to the Article 37.3 of LIB 2022 merely states
insurance company. that "the parties may agree to reinstate the
3.3. Provisions on Contract terminated life IC" without specifying the
Reinstatement form of this agreement, such as whether it
Unlike other types of ICs, life ICs are must be in writing, as required for the IC
concerned with the duration of human life, itself. In practice, disputes have arisen over
leading to long-term contracts that may asset-based ICs, but similar to life IC
extend for 5, 10, or even a lifetime. Due to reinstatement. These disputes have been
the extended premium payment periods, resolved and summarized in judgment No.
policyholders may face financial 37/2020/AL regarding the validity of asset-
difficulties preventing them from fulfilling based ICs in cases where the policyholder
their contracts, potentially resulting in paid insurance premiums after the premium
unilateral contract termination. In such payment period ended (source judgment
cases, Article 37.3 of LIB 2022 allows the based on the Director's Decision No.
parties to agree to reinstate the contract 28/2018/KDTM-GĐT dated June 26, 2018,
within 2 years. Conditions that may be regarding a trade dispute IC in Dong Nai
agreed upon for reinstatement include: Province) as follows:
(i) The policyholder has paid any “[4]... After receiving the insurance
outstanding insurance premiums. premium from Company N, the Joint Stock
Insurance Company P and Insurance
(ii) The reinstatement occurs within 2
Company P1 had no objections and did not
years from the termination of the life IC.
provide any written notice regarding late
(iii) This provision applies only in cases premium payments. As a result, both
where the life IC was unilaterally contracts became ineffective as of May 1,
terminated by the policyholder due to their 2015. However, Insurance Company P1
inability to continue, despite having the still accepted, issued value-added tax
option to extend premium payments, invoices and reported taxes for the two
excluding other scenarios. insurance premium payments received from
Given the long-term and savings- Company N. Therefore, Joint Stock
oriented nature of life ICs, most countries' Insurance Company P and Insurance
legal systems allow for the reinstatement of Company P1 implicitly acknowledged
contracts. This is intended to allow the Company N's late insurance premium
parties to continue exercising their rights payments and recognized the validity of
and fulfilling their obligations, thereby these two contracts. [5] Consequently,
avoiding the termination of contracts when when an insurance event occurs, Joint Stock
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Legislation on insurance contracts - some inadequacies and recommendations for
finalization
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Tran Linh Huan, Pham Thi Hong Tam
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